Femur density in alcoholism and after gastrectomy

The bone mineral mass in the distal end of the femur was evaluated in 121 men, half of which were alcoholics. It was demonstrated that in alcoholics the bone mass was significantly decreased but only in combination with previous gastrectomy.Financial support for this study was obtained from Alfred Österlunds Stiftelse and Herman Järnhardts Stiftelse.     

Changing Paradigms in Animal Models of Traumatic/Hemorrhagic Shock

Abstract To understand the complex network of pathophysiology after traumatic/hemorrhagic shock, mankind was particularly successful in using reductionistic approaches such as animal models to study the biology/physiology of normal states, to compare this with pathologic disease states and/or to follow the changes after modulation of pathologic states. One rationale for the study of animals is to discover and to develop effective therapies of traumatic/hemorrhagic shock that will lead to clinical testing in human patients. In this respect, three traditional traumatic/hemorrhagic shock models (uncontrolled bleeding, controlled fixed bleeding volume, and controlled decrements in blood pressure) are commonly applied, but must be critically reevaluated with regard to their clinical relevance under consideration of todays changing paradigms of knowledge on the pathophysiology of traumatic/hemorrhagic shock. Traumatic/hemorrhagic shock models with the endpoint of inadequate organ perfusion and tissue oxygenation mirror modern understandings of traumatic/hemorrhagic shock and seemed to be a solid basis for future investigations. Regarding this, the benefits of an oxygen debt shock model are discussed. With increasing knowledge in traumatic/hemorrhagic shock even further models may be necessary in the future.     

Demonstration of the 5-flap technique

Summary Demonstration of the 5-flap technique which is double opposed Z-plasty and Y – V advancement is presented. A 4×4 gauze serves to demonstrate this technique.The authors dedicate this paper to the dear memory of their teacher, the late Prof. Zvi Neuman, who passed away untimely on March 22, 1977     

Antibodies directed at mouse IL-2-R α and β chains act in synergy to abolish T-cell proliferation in vitro and delayed type hypersensitivity reaction in vivo

The anti-mouse IL-2-R chain mAb TM-1 which, by itself, does not affect IL-2-dependent proliferation throught the high affinity mouse IL-2 receptor, was shown to cooperate in a synergistic way with a set of anti-IL-2-R chain mAbs both in vitro and in vivo. In vitro, when associated at equimolar concentrations, the TM-1/anti- mAb association was four to ten times more efficient at inhibiting the proliferation of the CTL-L2 cell line than was a similar concentration of anti- mAb alone. In addition, a bispecific antibody in which a Fab' fragment of TM-1 was covalently linked to a Fab' fragment of one of the anti- mAb (5A2) was shown to be as efficient as the TM-1/5A2 association. The association of TM-1 with 5A2 was also tested in vivo in a sheep red blood cell-induced delayed type hypersensitivity (DTH) model. TM-1 which, by itself, had no effect on DTH, induced a two- to threefold decrease in the doses of 5A2 required to suppress this cell-mediated immune reaction.     

Interferon-β Is More Potent Than Interferon-α in Inhibition of Human Hepatocellular Carcinoma Cell Growth When Used Alone and in Combination With Anticancer Drugs

Background:The prognosis of advanced hepatocellular carcinoma (HCC) is extremely poor, but promising effects of chemotherapies combined with interferon (IFN) have been reported.Methods:To develop more effective combination therapies for HCC, we compared the antiproliferative effects of IFN- and IFN- in combination with various cytotoxic drugs on hepatoma cell lines using MTT assay and isobologram analysis.Results:IFN- was more potent than IFN- in inhibiting the cell growth of all cell lines (P < .05, two-way ANOVA). PLC/PRF/5 was more sensitive to either IFN, than HLE and HuH7. Cell growth of all cell lines was inhibited in a dose-dependent manner by 5-fluorouracil (5-FU), cisplatin (CDDP), and doxorubicin (DOX), but the sensitivities of these cells were considerably different. As for IFN-, synergistic effects were observed when combined with 5-FU and DOX on PLC/PRF/5 cells only, whereas IFN- showed synergistic effects with 5-FU and CDDP on HuH7 and PLC/PRF/5 cell lines.Conclusion:The spectra of the antiproliferative activity and synergistic effect of IFN- when combined with anticancer drugs are more potent than those of IFN-. Combinations of IFN- and anticancer drugs may provide a better treatment of HCC when combinations with IFN- are ineffective.Presented at the 56th Annual Cancer Symposium of the Society of Surgical Oncology, Los Angeles, California, March 5–9, 2003.     

AneuRx Device Migration: Incidence, Risk Factors, and Consequences

Success after endovascular abdominal aortic aneurysm repair (EVAR) is dependent on device positional stability. The quest for such stability has motivated different endograft designs, and the risk factors entailed remain the subject of debate. This study aims at defining the incidence, risk factors, and clinical implications of device migration after EVAR with the AneuRx® endograft. In this study we included all consecutive 109 patients submitted to primary AneuRx placement for infrarenal aortic or aortoiliac aneurysms. Preoperative computed tomography (CT) scans were reviewed for the following anatomic characteristics: neck length, diameter, angulation, calcification, and thrombus load; and sac diameter and thrombus load. Percentage of device oversizing relative to the proximal neck diameter was determined. All postoperative CT scans were reviewed, and the distance between the lowest renal artery and the craniad end of the device was measured. A 5-mm increase in such distance was considered indicative of device migration. Migration cumulative incidence was estimated by the Kaplan-Meier method, and its association with any of the preoperative anatomical characteristics was tested using Cox proportional hazards models. Median follow-up time was 9 (range, 1-31) months. Migration occurred in nine patients, corresponding to a 15.6% estimated probability of migration at 30 months (SE=5.1%). Migration was associated with the risk of proximal type I endoleak (hazard ratio=3.39, 95% confidence interval=1.46-7.87; p=0.007). This type of endoleak occurred in three of the migration-affected patients (33.3%); all of them were resolved by additional cuff placement at the proximal landing zone. No other migration-related reinterventions were performed. The only significant associations between anatomic factors and device migration probability were the protective effects of longer necks (odds ratio [OR]=0.71 for each additional 5 mm, p=0.045) and longer overlapped portions of neck and device (OR=0.56 for each additional 5 mm, p=0.003). There was a trend toward higher probability of migration among reverse-tapered necks (OR=1.75, p=0.109). Percentage of device oversizing correlated with early neck dilation (between preoperative and first postoperative diameters, correlation coefficient=0.4, p < 0.0001), but not with late neck dilatation (between first postoperative and 1.5-year scan diameters, correlation coefficient=0.29, p=0.112). There was a trend toward higher mean percentage of late dilation among migrators (11.4%, standard error of the mean [SEM] 2.6) than nonmigrators (5.7%, SEM=1) (p=0.08), but both groups had similar mean percentages of early dilation (3%, SEM=1.6%, vs. 5.5%, SEM=0.6%; p=0.365). This result indicates that device migration is not a rare event after AneuRx implantation. This phenomenon is associated with proximal type I endoleaks. Deployment of the endograft immediately below the renal arteries might help to prevent migration, since use of greater lengths of overlapped device relative to the proximal neck has a protective effect. Migration seems to be independent of the degree of device oversizing.Presented at the 29th Annual Meeting of the Peripheral Vascular Surgery Society, Anaheim, CA, June 4-5, Sergio M. Sampaio is a recipient of the Edward S. Rogers Clinical Research Fellowship in Vascular Surgery.     

Gastrointestinal motility of patients with Roux-en-Y reconstruction

The electromyographic activity of the gastrointestinal tract was studied in 28 patients undergoing gastric, biliary, and pancreatic operations with reconstruction of the gastrointestinal tract with a Roux-en-Y limb. The Roux-en-Y limb was constructed 1 to 5 years before the study in 8 patients (chronic Roux-en-Y) and at the operation in which the electrodes were implanted in 20 patients (recent Roux-en-Y). All four phases of the migrating motor complex (MMC) were identified in the gastrointestinal tract, including in the Roux-en-Y limb. The duration of the MMC was 82.4 ± 22.3 min in the patients with chronic Roux-en-Y and 89.0 ± 25.1 min in the patients with recent Roux-en-Y. Food ingestion converted the MMC to the fed pattern in the entire gastrointestinal tract, including the Roux-en-Y limb in 16 (76.2%) of 21 recordings of the patients with chronic Roux-en-Y and in 27 (84.4%) of 32 recordings of the patients with recent Roux-en-Y. The duration of the fed pattern was 170 ± 34 min in the patients with chronic Roux-en-Y and 154 ± 26 min in the patients with recent Roux-en-Y. The findings of this study indicate that the electromyographic activity of the Roux-en-Y limb is normal during both fasting and fed states, even many years after the construction of the Roux-en-Y.

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Resumen Se estudió la motilidad electromiográphica del tracto gastrointestinal de 28 pacientes sometidos a operaciones gástricas, biliares y pancreáticas con reconstrucción de tipo Roux-en-Y. El asa de Roux-en-Y fue construida 1–5 años antes del estudio en un grupo de ocho pacientes (Roux-en-Y crónica) y en otro grupo de 20 lose electrodos fueron implantados durante la operación (Roux-en-Y reciente). Se identificaron las cuatro fases del complejo motormigratorio en el tracto gastrointestinal, incluso en el asa de Roux-en-Y. La duración del CMM fue 82.4 ± 22.3 min en los pacientes con Roux-en-Y crónica y 89.0 ± 25.1 min en los pacientes con Roux-en-Y reciente. Con la ingesta de alimento se substituyó el CMM por el patrón postalimentación en la totalidad del tracto gastrointestinal incluso en el asa de Roux-en-Y, en 16 de los 21 registros (76.2%) de los pacientes con Roux-en-Y crónica y en 27 de los 32 registros (84.4%) de los pacientes con Roux-en-Y reciente. La duración del patrón postalimentacón fue 170 ± 34 min en los pacientes con Roux-en-Y crónica y 154 ± 26 min en los pacientes con Roux-en-Y reciente. Los hallazgos en este estudio indican que la actividad electromiográphica del asa de Roux-en-Y es normal durante las fases de ayuno o de alimentación, aún transcurridos muchos años de la confección del Roux-en-Y.

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Résumé L'activité électromyographique de l'intestin grêle a été étudiée chez 28 patients ayant eu des interventions portant sur le l'estomac, les voies biliaires ou le pancréas et comportant une reconstruction avec une anse en Y. Chez huit de ces patients, l'intervention initiale pendant laquelle cette anse en Y avait été mopntée, datait de 1 à 5 ans (anse en Y dite chronique). Chez les 20 autres patients, les électrodes pour mesurer l'activité électrique ont été placées pendant l'intervention initiale (anse en Y dite récente). Les quatre phases du complexe moteur migrateur (CMM) ont été identifiées sur l'intestin et sur l'anse en Y. La durée du CMM a été de 82.4 ± 22.3 min chez les patients ayant une anse en Y chronique, et de 89.0 ± 25.1 min chez les patients ayant une anse en Y récente. Pendant l'alimentation, la courbe d'activité dite d'alimentation a remplacé les CMM dans le tube intestinal en entier, y compris l'anse en Y chez 16 des 21 enregistrements (76.2%) des patients ayant une anse en Y chronique et chez 27 des 32 (84.4%) enregistrements des patients ayant une anse en Y récente. La durée des courbes dites d'alimentation a été de 170 ± 34 min chez les patients avec une anse en Y chronique et de 154 ± 26 min chez les patients avec une anse en Y récente. Les résultats de cette étude indiquent que l'activité électromyographique des anses en Y est normale pendant le jeûne et pendant l'alimentation, et ce même plusieurs années après la confection d'une anse en Y.

     

An interpretation of acute changes in plasma45Ca following parathyroid hormone administration to thyroparathyroidectomized rats

Acute changes in plasma calcium and⁴⁵Ca were studied in young adult male thyroparathyroidectomized (TPTX) rats injected with moderate doses of parathyroid hormone (PTH). For plasma calcium changes, comparison was made between rats fasted or fed prior to PTH injection. For plasma⁴⁵Ca changes, the effect of the time of administration of the radionuclide was also studied; this included rats injected with PTH 1 h after radionuclide (1 h⁴⁵Ca), 18 h later (18 h⁴⁵Ca) and more than 6 days later (6 day⁴⁵Ca). The results can be summarized as follows: (1) Plasma calcium changes were greater when PTH was injected into fed rather than into fasted rats. (2) PTH always produced a relative increase (compared to controls tested concurrently) in plasma⁴⁵Ca concentrations. This increase was the same in the 1 h⁴⁵Ca and the 18 h⁴⁵Ca groups. (3) Plasma⁴⁵Ca rose at least temporarily following PTH injection in the 18 h⁴⁵Ca group. (4) The⁴⁵Ca rise following PTH was always greater in fed than in fasted groups. (5) Plasma⁴⁵Ca specific activities (S.A.) tended to rise in the 6 day⁴⁵Ca group and to fall in the 18 h⁴⁵Ca group, following PTH injection. However, the⁴⁵Ca S.A. was always higher in fed than fasted groups. (6) In a few experiments in which³²P was injected with⁴⁵Ca, specific activity changes in plasma⁴⁵Ca following PTH injection werenot accompanied by similar changes in³²P specific activity.These results could not be adequately explained by PTH effects on bone resorption, but the data supported the postulate that PTH controls plasma calcium concentrations by increasing transport of calcium through the osteocyte-lining cell (osteoblast) bone cell complex from the bone fluid compartment to the ECF.     

Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration: Part II. Cervical spine

A new radiographic grading system for a more objective assessment of lumbar intervertebral disc degeneration has been described and tested in Part I of this study. The aim of the present Part II of the study was to adapt this system to the cervical spine, and to test it for validity and interobserver agreement. Some modifications of the grading system described in Part I were necessary to make it applicable to the cervical spine. Its basic structure, however, stayed untouched. The three variables Height Loss, Osteophyte Formation and Diffuse Sclerosis first have to be graded individually. Then, the Overall Degree of Degeneration is assigned on a four-point scale from 0 (no degeneration) to 3 (severe degeneration). For validation, the radiographic degrees of degeneration of 28 cervical discs were compared to the respective macroscopic ones, which were defined as real degrees of degeneration. The interobserver agreement was determined between one experienced and one unexperienced observer using the radiographs of 57 cervical discs. Quadratic weighted Kappa coefficients () with 95% confidence limits (95% CL) were used for statistical evaluation. The validation of the new version of the radiographic grading system showed a moderate agreement with the real, macroscopic overall degree of degeneration (=0.599, 95% CL 0.421–0.786). In 64% of all discs the real overall degree of degeneration was underestimated but never overestimated. This underestimation, however, was much less pronounced and the Kappa coefficients were significantly higher for the three variables: Height Loss, Osteophyte Formation, and Diffuse Sclerosis separately. The agreement between the radiographic ratings of the experienced and the unexperienced observer was substantial for the overall degree of degeneration (=0.688, 95% CL 0.580–0.796), almost perfect for the variable, Height Loss, moderate for Osteophyte Formation and fair for Diffuse Sclerosis. In conclusion, we believe that the new version of the radiographic grading system is a sufficiently valid and reliable tool to quantify the degree of degeneration of individual cervical intervertebral discs. In comparison to the version for the lumbar spine described in Part I, however, a slightly higher tendency to underestimate the real overall degree of degeneration and somewhat higher interobserver differences have to be expected.Part I of this article can be found at http://dx.doi.org/10.1007/s00586-005-1029-9     

The question of von Korff fibres in mammalian dentine

The distribution and orientation of the fibres of von Korff have been studied in developing dentinal surfaces and in fractured and in polished acid etched surfaces of mature dentine both with the scanning electron microscope and indirectly via a carbon replica technique for the transmission electron microscope. It has been found that von Korff fibril bundles can be visualized in prepared surfaces of mature dentine and that their specific location and conformation in the finished tissue can be related to the developing surface. Von Korff fibrils are characteristic of the first-formed (mantle) dentine and are not found in the bulk of the dentine formed later (circumpulpal dentine). Structures superficially similar to von Korff fibres occur at the developing surface during the later stages of dentine development but are incorporated into the dentinal matrix in an entirely different manner.There is a third or intermediate zone between the very irregular and fibrillar mantle dentine and the very regular and relatively homogenous circumpulpal dentine. This zone is distinguishable on the basis of the distribution and orientation of von Korff fibril bundles, although the three zones merge gradually with one another and vary in relative thickness in different species. The majority of von Korff fibril bundles in mature dentine are truly radial for only a small part of their course. The presence of von Korff bundles in the wombat can be related to the absence of enamel tubules in this marsupial. Areas of mantle dentine lacking von Korff fibrils may alternate with areas containing many fibrils in some placetal mammals. This presence or absence of von Korff fibrils can be related to the presence or absence respectively of tubules in the overlying enamel.

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Zusammenfassung Die Verteilung und Lagerung der von Korffschen Fasern ist auf sich entwickelnden Dentinoberflächen und auffrakturierten und polierten, säuregeätzten Oberflächen von reifem Dentin untersucht worden, und zwar auf den Scanning-Elektronen-Mikroskop und indirekt mit der Kohleabdruck-Technik auf dem Transmissions-Elektronen-Mikroskop. Dabei wurde festgestellt, daß von Korffsche Fibrillen-Bündel auf vorbehandelten Oberflächen von reifen Dentin sichtbar gemacht werden können, wobei ihre spezifische Lage und Verteilung im ausgewachsenen Gewebe mit der Wachstumszone in Zusammenhang gebracht werden kann.Die von Korffschen Fibrillen sind charakteristisch für das zuerst gebildete, sog. Mantel-Dentin. Dagegen finden sie sich in der Masse des später gebildeten Circumpulpal-Dentins nicht. Den von Korffschen Fasern in ihrer Struktur ähnliche Fasern treten an der sich entwickelnden Oberfläche im letzten Stadium der Dentinbildung auf, werden jedoch auf ganz andere Weise in die Dentinmatrix verwoben.Eine dritte oder intermediärzone konnte zwischen dem recht unregelmäßigen, fibrillären Mantel-Dentin und dem ausgesprochen regelmäßigen, relativ homogenen Circumpulpal-Dentin gefunden werden. Dieser Anteil läßt sich von den beiden andern auf Grund der Lagerung der von Korffschen Faserbündel unterscheiden, obschon alle drei Zonen ineinander übergehen und in ihrer Dicke bei den verschiedenen Gattungen variieren. Die Mehrzahl der von Korffschen Faserbündel im reifen Dentin ist in ihrem Verlauf nur auf einer kurzen Strecke wirklich radär gelagert. Das Vorkommen von Korffscher Faserbündel beim Wombat läßt auf fehbende Tubuli in Zahnschmelz dieser Beuteltiere schließen. Bereiche von Mantel. Dentin mit fehlenden von Korffschen Faserbündeln können bei einigen placentären Säugetieren mit solchen, die viele Fibrillen enthalten, abwechseln. Dieses Vorhandensein oder Fehlen der von Korffschen Fibrillen kann mit vorhandenen, resp. fehlenden Tubuli im darüberliegenden Zahaschmelz in Zusammenhang gebracht werden.

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Résumé La distribution et l'orientation des «fibres de von Korff» ont été étudiées au niveau de surfaces dentinaires en voie de développement et surfaces fracturers ainsi qu'au niveau de surfaces polies de dentine adulte, puis attaquées à l'acide, à la fois avec un microscope électronique «scanning» et indirectement à l'aide de répliques de carbone, examinées à l'aide d'un microscope électronique par transmission. Les faisceaux de fibrilles de von Korff peuvent être mis en évidence au niveau de la dentine adulte et leur situation spécifique ainsi que leur structure sont caractéristiques au niveau de la surface de développement. Les fibrilles de von Korff sont situées dans la première couche de dentine formée et ne se trouvent pas dans la masse dentinaire, formée plus tardivement (dentine circumpulpaire). Des structures ressemblant à des «fibres de von Korff» se rencontrent au niveau de la surface en voie de développement, au cours des stades tardifs de la dentinogenèse, mais elles sont incorporées dans la matrice dentinaire d'une façon totalement différente.Entre la première couche de dentine fibrillaire et irrégulière, formée, et la couche de dentine circumpulpaire, régulière et homogène, on observe une troisième zone intermédiaire. Cette zone se différencie par la distribution et l'orientation des faisceaux de von Korff. Cependant ces zones fusionnent progressivement les unes avec les autres et présentent une épaisseur variable d'une espèce à l'autre. La majorité des faisceaux fibrillaires de von Korff dans la dentine adulte ne présente un trajet radial vrai que sur une infime partie de leur parcours. La présence de faisceaux de von Korff chez le wombat d'Australie peut être mise en rapport avec l'absence de canalicules de l'émail chez ce marsupial. Des régions de dentine périphérique, sans fibrilles de von Korff peuvent alterner avec des régions contenant de nombreuses fibrilles dans certains mammifères placentaires. La présence ou l'absence de fibrilles de von Korff peut correspondre respectivement à la présence ou l'absence de «canalicules» dans l'émail sus-jacent.

     

The distribution of extracellular matrix vesicles in healing of rat tibial bone three days after intramedullary injury

Summary The distribution of extracellular matrix vesicles on the third day of bone healing was studied by morphometric analysis of transmission electron micrographs. Detection and grouping of the vesicles was performed according to type, diameter, and distance from the calcified front. The different types were selected as follows: vesicles with electron-lucent contents (empty), vesicles with amorphous electron-opaque contents (amorphic), vesicles containing crystalline depositions (crystal), and vesicles containing crystalline structures with ruptured membranes (rupture). The majority of vesicles were between 0.07 µm and 0.12 m in diameter and were located at less than 3 m from the calcified front. The distribution of the empty, amorphic, crystal, and rupture vesicles was 23.2%, 74%, 2.5%, and 0.3% respectively. Their sequence of arrangement according to diameter was as follows: empty, amorphic, crystal, and rupture, the empty vesicles constituting the smallest and the rupture the largest type. Distances from the calcified front were similar for the empty, amorphic, and crystal vesicles, while the rupture type was located nearest to the front. The present observations support the widely acknowledged hypothesis on the role of extracellular matrix vesicles in mineralization. It is thought that the secretion of empty vesicles from the cell is followed by intravscular accumulation of amorphous Ca and Pi to form a hydroxyapatite crystal that, in turn, ruptures the vesicle's membrane. The maturation process is accompanied by an increase of the vesicular diameter and its approximation to the calcifying front.     

Predicting lethal outcome after severe head injury — A computer-assisted analysis of neurological symptoms and laboratory values

Summary A total number of 58 parameters (laboratory values, neurological symptoms, and vegetative parameters) were evaluated in 150 patients during the first seven days after severe head injury. The patients were divided into two groups, survivors and non-survivors. Eight easily evaluable routine parameters with the most significant differences between the two groups of patients were used for statistical evaluation of a no survival chance score. These highly indicative parameters are serum osmolarity and urea, blood glucose, total bilirubin, motor reaction to stimuli, body temperature, respiratory activity, and pupil reaction. A low survival chance limit was evaluated from each of these parameters by computer analysis. None of the patients in the series survived when three or more of these eight parameters had climbed beyond the limit. So far, the system is able to predict no survival chances in 50.8% of the non-survivors some six days prior to death; 80% of these predictions could be made by the fourth day after injury.     

Diphenylamine-induced renal lesions in the chicken

Summary Chronic intoxication with diphenylamine (DPA), which causes a cystic kidney disease in the rat and the guinea-pig, caused degeneration of the renal tubular epithelium in the chicken. This was similar to but much more serious than that preceding the formation of cysts in the rodents, but did not actually result in cyst formation, probably because of the high mortality rate observed in the birds even at this early stage. In the chicken until now it had been possible to obtain a pattern of renal cysts only with polychlorinated biphenyls (PCB) which also induce the chick oedema syndrome. The renal lesions due to DPA in the chicken were similar to those produced by PCB, but were not accompanied by oedema, which suggests that chick oedema caused by PCB is not due to renal insufficiency. The differences in the renal lesions noted in the various animal species give credit to the hypothesis that DPA may have two effects on the tubular epitelium, one stimulating cell proliferation and one leading to degeneration. Cysts may be formed only in those species in which there is cell proliferation.     

Experimental study of drainage and granulation in response to the intra-articular injection of particles in rat knee joints

Reactive granulation and drainage of intraarticularly injected plastic particles in rat knee joints was examined by light and electron microscopy. The knee joints and associated iliac lymph nodes were excised at various intervals after the injection of latex beads (1 m) or fluoresbrite particles (0.2 m or 10 m) from 5 min until 3 months after the injection. Particles in the lymphatic or blood vessels were successfully demonstrated by an enzyme-histochemical method (5-nucleotidase staining). Five min after the injection, most of the particles were scattered on the surface of the synovial membrane, and some particles were phagocytosed by synovial lining cells. After 5 h, neutrophils had phagocytosed particles which adhered to fibrin in the joint cavity. Twelve h after the injection, after the neutrophils had died, those same particles were phagocytosed by macrophages in the joint cavity. One day after the injection, Fluoresbrite particles (0.2 m) phagocytosed by macrophages were found in the iliac lymph nodes, while latex particles (1 m) were detected in the iliac lymph nodes 3 days after the injection. Some Fluoresbrite particles (10 m) were seen in the 5-nucleotidase-positive lymphatic vessels in the synovial membrane. Three months after the injection, many macrophages filled with particles had formed granulation tissue in the synovial membrane, and macrophages containing phagocytosed particles were also seen increasingly in the iliac lymph nodes. Our findings suggested that neutrophils and macrophages phagocytosed injected particles in the joint cavity, and that the macrophages brought the particles into the deep layer of the synovial membrane. Phagocytic macrophages also carried the particles to the iliac lymph nodes through lymphatic vessels in the synovial membrane. There were no morphological differences in the processes of granulation and drainage between the two different sized plastic particles (1 m and 0.2 m), except for the behavior of the macrophages phagocytosing the particles.     

242. Korrelation klinischer und biochemischer Befunde mit dem Schweregrad einer bakteriellen Peritonitis

Zusammenfassung Anhand von Verlaufsdaten 66 chirurgischer Patienten mit einer bakteriologisch gesicherten Peritonitis sollten harte und weiche Kriterien zur Beurteilung des Schweregrades differenziert werden. Untersuchungskriterien: 1) regionale Ausbreitung, 2) Entwicklung eines Organod. Systemversagens, 3) Leukocytose/Thrombopenie, Körpertemperatur, 4) die Plasmamediatoren Endotoxin/Prostaglandin F₂ (PGF₂), 5) Anamnesedauer (Erstsymptom bis OP), 6) Anzahl erforderlicher Reoperationen und 7) Lebensalter. Zuzuordnende Schweregrade: Grad 1: überlebt, Grad 2: mit Komplikationen überlebt, Grad 3: nicht überlebt. Danach erweisen sich als harte Kriterien: 1) Lokalisation, 2) Anamnesedauer, 3) Leukocytose, 4) Endotoxin > 100 Eu/ml, PGF₂ > 500 pg/ml, 5) Körpertemperatur 38,5°C.     

219. Ursachen und Behandlungsprobleme der syminetrischen Unterschenkelfraktur

Zusammenfassung Als Ursache der symmetrischen Unterschenkelfrakturengibt es direkte Trauma durch Kantensturz, Fahrzeugkollision oder Stoßstangenanprall. Gehäuft treten die zweizeitigen Kombinationsverletzungen Beine, Kopf, Becken auf. Lokal überwiegen die offenen Trümmerbrüche verschiedener Höhe. Gefäß-Nerven-Verletzung ist relativ selten. Therapeutisch erfordert die Mehrfachverletzung individuelle Indikationsstellung nach vitaler Dringlichkeit. Daher Osteosynthese praktisch nur verzögert primär möglich, und dann eventuell mit zwei Operationsgruppen. Vorbeugend sind verbesserte Sicherheitssysteme zur Unfallverhütung zu fordern.     

Digital subtraction angiography (DSA): New perspectives in angiography

Summary Digital subtraction angiography (DSA) has strongly influenced angiographic procedures. Because it is less invasive it has increased the total number of angiographies in all places where it was introduced. The paper gives an introduction to the procedure explaining the roles of digital and subtraction in DSA. It is written from a technical point of view. The examples are taken from and with the DVI system.     

51. Die Behandlung von Kniegelenksarthrosen mit Trasylol

Zusammenfassung 30 ältere Patienten mit Kniegelenk-Arthrosen wurden mit dem Fermentinhibitor Trasylol intra-artikulär mit gutem Erfolg behandelt. Durch den Fermentinhibitor werden die bei der Arthrose entstehenden Kinine als schmerzauslösende Substanzen sofort inhibiert, ebenso die vorhandenen Proteinasen, die zum Abbau der Knorpelgrundsubstanz führen.

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Summary Thirty old patients with arthroses of the knee joint have been treated with the enzyme inhibitor Trasylol by intra-articular administration with good success. The enzyme inhibitor inhibited the kinins which develop in arthrosis as compounds that trigger off pain. It also inhibits the proteinases, which cause dissociation of the cartilage ground substance.